Hospital representatives from Billings (Mont.) Clinic and Intermountain Healthcare in Salt Lake City testified before the Senate Committee on Finance yesterday, urging Congress to take action on Medicare Recovery Auditors, or RACs.
Sens. Max Baucus (D-Mont.) and Orrin Hatch (R-Utah) established the hearing to "simplify the way [RACs] interact with providers," which should "increase efficiency and may also reduce some unnecessary burden on doctors and hospitals," according to a statement.
J.J. Carmody, director of reimbursement at Billings Clinic, and Suzie Draper, vice president of business ethics and compliance at Intermountain, said Medicare RACs have become burdensome at their respective organizations. Ms. Carmody said since her hospital's regional RAC began auditing in May 2010, Billings Clinic has had to submit 6,000 records involving more than $45 million, or 14 percent of its overall Medicare payments.
Ms. Draper added that Medicare RACs have also not been completely accurate in their audits. Intermountain's RAC audited roughly $120 million in Medicare payments, but only $16,000 has been returned to the program due to Intermountain's successful appeal efforts.
Robert Rolf, vice president of CGI, the Region B Medicare RAC, also testified. He argued that CGI and other RACs have "worked diligently to implement the program in an open and transparent fashion" and that the current system has worked to recover overpayments while not incenting RACs to "over-audit."
The hearing came as Congress weighs the Medicare Audit Improvement Act, a bipartisan measure that would reform how RACs could request medical records from providers and penalize RACs for making auditing errors.